Daytime Urinary Continence Research Articles

The Z-shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

Study Type - Therapy (case series). 4. To evaluate the results in terms of functional results and morbidity of Z-shaped ileal neobladder performed in a single center. 329 consecutive male patients who had an orthotopic bladder replacement using the Z-shaped ileal neobladder between May 1990 and January 2009. The mean age of the patients was 64.4 ± 9.6 years, with a mean follow-up of 59.4 ± 55 months. Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture. Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1-5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication. Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months. Hyper-continence with subsequent need for CISC was observed in 4%. In our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an 'expected' complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.

Long-term outcomes of radical cystectomy with preservation of prostatic capsule

We report our results of orthotopic ileal neobladder after radical cystectomy with prostatic adenomectomy with regard to urinary continence, sexual outcome and disease control. Between March 2003 and July 2004, 22 men with bladder transitional cell carcinoma (mean age 65.0) were analyzed. They underwent radical cystectomy with prostatic adenomectomy with preservation of the prostatic capsule, seminal vesicles and orthotopic ileal neobladder. Urinary continence was assessed after 2 days, 2 months, 6 months and 1 year. Preservation of sexual function was defined as the ability to have sexual intercourse and was assessed after 2-, 6-, and 12-months postoperatively. Overall survival and cancer-specific survival were assessed. Median postoperative follow-up was 60 months. Daytime and nighttime urinary continence after 48 h was 47 and 14%, respectively. After 2, 6 and 12 months, these rates were 74 and 16%, 85 and 26%, and 94 and 31%, respectively. Sexual intercourse was achieved in 69% of patients. Overall survival rate was 68%, and cancer-specific survival rate was 73%. Overall survival rates according to pathologic stage for pT0, pT1, pT2 and pT3 were 100, 60, 71 and 57%, and cancer-specific survival were 100, 80, 71 and 57%, respectively. Urinary continence and sexual function achieved by radical cystectomy with prostatic adenomectomy with orthotopic ileal neobladder seem to be similar to those achieved by the conventional technique with satisfactory oncologic results.

Le récepteur sensible au calcium : de la physiopathologie à l’implication thérapeutique: D’après la conférence de M. Ruat. 25e congrès de la Société française d’endocrinologie Lille, 1–4 octobre 2008

To describe our technique and outcomes of robotic-assisted nerve-sparing cystoprostatectomy with prostatic apex preservation and orthotopic ileal conduit urinary diversion in young men undergoing robotic-assisted radical cystectomy (RARC) for the management of urothelial carcinoma.Young men (<40 years old) with the diagnosis of urothelial carcinoma undergoing RARC with orthotopic neobaldder formation were eligible for our technique of nerve-sparing cystoprostatectomy with prostatic apex preservation at the time of orthotopic ileal conduit urinary diversion. During the apical prostatic dissection step of the RARC, the plane of dissection is directed under the dorsal vein complex and through anterior prostatic fibromuscular stroma. This plane is further carried through the prostatic urethra, transecting the most caudal aspect of prostatic peripheral zone posteriorly, to create a long urethra and a posterior urethral plate formed by peripheral zone of the prostate, which serves as a robust, long stump for the subsequent vesicourethral anastomosis.From January 2013 to January 2014, 3 men were treated with RARC and intracorporeal neobladder urinary diversion based on the described technique. There were no intraoperative complications. Two patients experienced grade II complications postoperatively. Pathologic assessment demonstrated negative surgical margins in all 3 cases. With mean follow-up time of 28.2 months, 2 out of 3 patients are free from disease recurrence. All patients report daytime urinary continence with no pad usage and potency without the need for phosphodiesterase-5 inhibitors.RARC with bilateral nerve and apical preservation can be performed safely in appropriately selected young patients with excellent functional and acceptable short-term oncologic results.

Ileal orthotopic neobladder after pelvic exenteration for cervical cancer

Objective We aimed to describe our preliminary experience in creating an ileal orthotopic urinary conduit in patients with a history of pelvic irradiation undergoing pelvic exenteration for recurrent cervical cancer and to evaluate the feasibility, complication rates, and outcomes of this procedure. Methods A retrospective chart review was performed in all 6 patients who underwent ileal orthotopic neobladder creation at our institution between January 2005 and March 2008. Main outcome measures were surgical complications, continence rate, neobladder function, and oncologic outcome. Results The mean patient age was 46.6 years (range, 38–61). Four patients underwent anterior exenteration and 2 total pelvic exenterations. There were no intraoperative complications. The median operative time was 456 min (range, 372–600). The median time to create the orthotopic urinary conduit was 70 min (range, 55–90). Three patients had postoperative neobladder anastomotic leak. Two of them had this complication successfully managed conservatively and 1 surgically. Daytime urinary continence was good or satisfactory in 4 of 6 patients. Nighttime urinary continence was good or satisfactory in 3 of 6 patients. All patients reported being satisfied with their decision to undergo this procedure. Median follow-up time was 20.5 months (range, 6–34). At last visit, 3 patients were alive without evidence of disease, 1 was alive with stable retroperitoneal disease, and 2 had died of disease recurrence after exenteration. Conclusions Ileal orthotopic neobladder creation in patients undergoing exenteration for recurrent cervical cancer is feasible after radiation. The rate of urinary continence is acceptable.

Functional and oncological outcomes after orthotopic neobladder reconstruction in women

To review our experience with orthotopic neobladder reconstruction (ONR) in women, highlighting functional and oncological outcomes, as ONR has been used increasingly for urinary diversion in women after radical cystectomy (RC), largely due to a better understanding of the natural history of urothelial cell carcinoma (UCC) and of the anatomy underlying the female continence mechanism, but defining the safety and long-term efficacy of ONR remain important to expanding its use. We identified 59 women who had RC with ONR between 1995 and 2006 at the Mayo Clinic. Their records were reviewed for clinicopathological demographics, and functional and oncological outcomes. The median (range) age at surgery of the women was 62 (20-82) years, and the median follow-up was 29.2 (1-141) months. Fifty-three women had RC for malignant disease, including UCC in 47. Five women (8.5%) required resection of the anterior vaginal wall during surgery, while 39 (66%) had concurrent hysterectomy. One patient had a positive surgical margin, at the left distal ureter, on final pathology. Thirteen (22%) patients had perioperative complications, including two (3%) who required reoperation. In addition, three patients (5%) developed a neobladder-vaginal fistula after RC with ONR, requiring surgical repair. At the last follow-up, daytime urinary continence (defined as needing no pads) was reported by 44/49 (90%) patients, while 28/49 (57%) had achieved continence at night. Seventeen (31%) patients required intermittent self-catheterization to facilitate emptying of the neobladder. Fifteen (28%) women had recurrence of disease, at a median of 8 (2-36) months after ONR, including seven (13%) who developed a pelvic recurrence. Twelve (20%) patients died during the follow-up, with four (8%) dying from UCC at a median of 14 (11-65) months after surgery. ONR provides a safe and effective option for urinary diversion in women, with oncological and functional outcomes similar to those for men. Thus, the technique remains a preferred option for urinary diversion in appropriately selected women treated with RC.

The Oncologic and Functional Results of the Ileal W-neobladder with a Serous-lined Extramural Tunnel

Purpose: We wanted to analyze the oncologic and functional outcomes of radical cystectomy and creation of an orthotopic ileal neobladder with a serous-lined extramural tunnel. Materials and Methods: There were 110 patients and 101 patients were male (mean age: 58.7 years, age range: 35-78 years). All these patients underwent radical cystectomy and creation of a ileal W-shaped neobladder with a serous-lined extramural tunnel, and all the procedures were done by one surgeon. The median period of follow-up was 28.9 (range: 6-95) months. The Assessing the patients’ clinical history, physical examinations, complete laboratory tests, CT scans and bone scans were performed postoperatively for the evaluation of recurrence and complications. The voiding patterns of 77 patients of the 110 patients were surveyed. Results: Five-year-overall survival was 56% and the median survival period was 66.1 months. The tumor recurrence rate was 39.1% (43 patients) and 21 (19.1%) patients died due to progression of cancer. The daytime and nighttime urinary continence rates at postoperative 1 year were 87% and 79%, respectively. Sixty three (81%) patients among the 77 patients had no voiding problems after the procedures. Nine patients still had severe incontinence and 5 patients still suffered from voiding difficulty. Renal functional deterioration developed in 3 patients (2.8%); however, no patients were on dialysis. Acute pyelonephritis was observed in 12 patients and recurrent pyelonephritis occurred in 6 patients. Ureter-ileal anastomosis site stricture was occurred in 5 renal units. No reflux from the ileal bladder into the ureter was observed. Conclusions: Radical cystectomy and an orthotopic ileal neobladder using a serous-lined extramural tunnel for patients with invasive bladder cancer were effective and durable procedures in terms of the oncologic and functional outcomes. (Korean J Urol 2008;49:797-803) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Urine alarms and prompts for fostering daytime urinary continence in a student with multiple disabilities: a replication study.

The study evaluated a treatment approach based on urine-alarm signals and staff prompts to foster daytime urinary continence of a student with multiple disabilities. Reinforcement was used for urination in the toilet. The study alternated two baseline with two treatment phases. A 3-mo. follow-up also occurred. The student became almost totally free from large urinary accidents, replacing them with self-initiated toileting and small accidents (wetting only a disposable tissue), and retained his improvement over time. Implications of the findings were discussed.

COMMENTARY ON 'URINE ALARMS AND PROMPTS FOR FOSTERING DAYTIME URINARY CONTINENCE IN A STUDENT WITH MULTIPLE DISABILITIES: A REPLICATION STUDY' BY LANCIONI, VAN BERGEN, AND FURNISS (2002)

Comments are made on successful use of auditory plus vibratory aids in fostering daytime urinary continence by a 14-yr.-old boy with multiple disabilities, including severe hearing loss.

Ileal Neobladder for Urinary Bladder Replacement following Total Pelvic Exenteration for Rectal Carcinoma

Objective: The aim of this study was to determine the feasibility of using the ileal neobladder as a substitute for the urinary bladder following total pelvic exenteration for rectal carcinoma. Patients and Methods: Between 1992 and 1998, we performed total pelvic exenteration with ileal neobladder in 5 men with rectal carcinoma. Four patients had primary tumors, and one had recurrent disease after low anterior resection for rectal carcinoma. Histological types were adenocarcinoma in 4 and squamous cell carcinoma in 1. Invaded organs were: the urinary bladder in 1, the urinary bladder and prostate in 2, the prostate and seminal vesicle in 1, and the prostate in 1. Results: There was no operative death. In 1 patient, an ileal conduit was needed because of partial necrosis of the neobladder. Minor leakage on the dorsal wall of the neobladder occurred in 2 patients, which was successfully stopped with simple closure and a gluteus maximus fasciocutaneous flap, respectively. All except one patient with the ileal conduit could void via the urethra. Complete daytime urinary continence was achieved, but nocturnal continence was maintained with voiding once or twice per night. As the urodynamic state, the mean maximum flow rate was 20.9 ml/s (range 9.0–34.1), the mean average flow rate was 7.7 ml/s (range 3.0–11.0), and the mean voided volume was 285.5 ml (range 160–432). The mean length of follow-up was 47.8 months. One patient died of local recurrence 38 months postoperatively, and 1 died of pneumonia 10 months postoperatively. Both patients could void via the urethra until death. The other three patients are currently alive without any evidence of recurrence. Conclusions: Although total pelvic exenteration is a laborious surgical procedure, an ileal neobladder could be a good alternative to the urinary bladder enabling the patients to void via the urethra with urinary continence.

URINE-TRIGGERED ALARM SIGNALS AND PROMPTS TO PROMOTE DAYTIME URINARY CONTINENCE IN A BOY WITH SEVERE INTELLECTUAL DISABILITY

A strategy involving urine-triggered alarm signals and prompts combined with positive reinforcement for appropriate urination was employed for promoting daytime urinary continence in a boy with severe intellectual disability. The strategy, which was applied only in the day centre the boy attended, seemed effective for promoting self-initiated toileting actions and for eliminating almost totally large urinary accidents. Some small urinary accidents (consisting of wetting small areas of the underpants) remained. Implications of the findings are discussed.

Lower urinary tract reconstruction in the female using the kock ileal reservoir with bilateral ureteroileal urethrostomy: Update of continence results and fluorourodynamic findings

To update continence results and present fluorourodynamic data in 17 female patients undergoing orthotopic lower urinary tract reconstruction with the Kock ileal urethrostomy following cystectomy. Continence results, voiding pattern, and overall patient satisfaction were evaluated by means of patient survey. Fluorourodynamic data and abdominal leak point pressures were obtained in 6 patients. Complete daytime urinary continence was reported in 93% of patients, whereas complete nighttime continence was reported by 87% of patients. Fluorourodynamic studies demonstrated excellent neobladder capacity with low reservoir pressure in all cases. Abdominal leak point pressure measurements confirmed normal urethral sphincter function. Excellent results with respect to urinary continence, voiding pattern, patient satisfaction, and reservoir function can be expected in women undergoing orthotopic lower urinary tract reconstruction.

Transpubic Cystectomy and Ileocecal Bladder Replacement after Preoperative Radiotherapy for Bladder Cancer

Radical cystectomy was modified by leaving the apical prostatic capsule to facilitate anastomosis of the isolated ileocecal segment to the urethra and to preserve erectile potency. The transpubic approach was used to increase the exposure, and to facilitate dissection and anastomosis. A total of 15 patients with stages T1 to T4 bladder tumors underwent the operation: 13 after preoperative radiotherapy with 4,000 rad and 2 had salvage cystectomy after 6,000 rad.One patient died postoperatively. The remaining 14 patients underwent urodynamic evaluation 3 to 6 months postoperatively. The maximum urine flow rates were almost normal and none of the patients had significant residual urine. Daytime urinary continence was satisfactory in 13 patients and 1 was moderately incontinent. All of the patients were incontinent at night, probably owing to peristaltic contractions in the intestinal bladder and relaxation of the pelvic floor muscles.Preoperatively, 8 patients experienced erections and 7 had intercourse. Postoperatively, erectile potency was preserved in 4 patients and 3 had sexual function. No orthopedic disability occurred postoperatively. The median followup was 20 months, with a range of 3 to 30 months. There have been no local recurrences. A year postoperatively 6 of 9 patients had sterile urine.This technique makes it possible to avoid a urinary stoma, to obtain satisfactory voiding and urinary continence in almost all cases, and to cystectomy.